| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,574 |
3,561 |
$224K |
| D0210 |
Intraoral - complete series of radiographic images |
2,874 |
2,861 |
$128K |
| D9430 |
|
3,655 |
3,214 |
$113K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
884 |
514 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,513 |
820 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
1,421 |
1,417 |
$89K |
| D0350 |
|
7,395 |
2,244 |
$73K |
| D1120 |
Prophylaxis - child |
1,602 |
1,597 |
$64K |
| D1110 |
Prophylaxis - adult |
563 |
557 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,856 |
2,892 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,447 |
2,429 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,169 |
1,161 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
300 |
146 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
28 |
18 |
$13K |
| D0330 |
Panoramic radiographic image |
841 |
836 |
$13K |
| D4341 |
|
177 |
46 |
$12K |
| D4910 |
|
159 |
158 |
$12K |
| D9910 |
|
306 |
133 |
$10K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
64 |
17 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
59 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D1310 |
|
100 |
99 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
37 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
25 |
$2K |
| D2140 |
|
46 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
177 |
177 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
46 |
$2K |
| D9222 |
|
17 |
17 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
159 |
157 |
$2K |
| D2954 |
|
17 |
15 |
$2K |
| D0603 |
|
101 |
100 |
$1K |
| D0270 |
|
103 |
99 |
$503.50 |
| D9993 |
|
12 |
12 |
$0.00 |
| D1330 |
|
253 |
253 |
$0.00 |